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Posted 3/16/2011 3:36 PM (GMT 0)
Hi,

Diamonds the wife here. I'd like to thank all of you who have sent us good info, especially Bill 88 who told me that he has heard that" others have recommended our Dr " as well as his other suggestions. By the way, a good  Philly" How YOU doin?"

 There are many of you who came to our recue with kindness May God Bless You. Am I allowed to say that? We were and I am sure others feel like" babes lost in the wood". Did I just say wood?

My husband is doing well with continency and others things have been starting to look up. No pun intended. I heard from the Dr. that sometimes you get good nerve responses at first and then things quiet down for  awhile and hopefully start to bounce back

ANYWHO, I have a question in regards to his patholgy report. Everything came back that the PC was contained except for 1 + posterier apica margin.

The DR. said something to the effect that it is not a true positive margin but that there is some microsc. tearing . Also, he indicated that during surgery, when going around the prostate, he first cut too narrow and into the capsule but then cut wider so as to cut around the outside of the prostate 

I did some reading from a study that indicated that 1 + apica margin does not increase his chances of a recurrence if all other surgical pathology iindicates the pc was kept i the capsule. ( ie neg sem ves, lymph nodes, perineural,etc.)

One other thing.. his Gleason was upgraded to 3+4 from 3+3. How much different are the two in terms of the chances of recurrence and how different is it from 4+3 in terms of the same ?

Thanks.

Does anyone have any information in regards to this. Thank you, again

 

Posted 3/16/2011 5:42 PM (GMT 0)
DI:

I think that the surgery was successful for your man. The pathology is reasonable. It is possible that what the surgeon said is true. If he made two incisions in the apex area, the first closer to the prostate, or actually into it, and then another further away, then the tissue the pathologist examines may have more edge surfaces than normal and the cancer at the margin may be accounted for by examination of the tissue taken from further away. The pathologist and surgeon should not discuss the tissue examination until after the pathologist has finished his work. This is to prevent any (ahem) unprofessional findings. After the path report is filed then it can be read by another pathologist to determine if any questions can be resolved. I do not know if his situation qualifies as one worthy of another opinion. I doubt it would be relevant unless psa began to rise and radiation was considered and a target was worth looking for.
The G score change is actually rather common. 3+4 is more like a G6 and 4+3 is more like an 8. Do you have the actual report? Please obtain it and read it closely. The pathologist may indicate the amount or percentage of G3 and G4. More G3 and less G4 is preferred. In the meantime have that man keep healing! Most tissue repair occurs during sleep so lots of rest and relaxation.
Posted 3/16/2011 6:11 PM (GMT 0)
Hey Tarhoosier,

Thanks for the info. I looked for the % of 3s vs 4 on the Gleason post surgical report and did not see it . Also, what do you think of the Dr's remark that the +apica margin might be the result of tearing of the tissue? Would this not result in cancer being left in? You sound like you have professional surgical knowledge in re this

Thanks again

Posted 3/16/2011 6:23 PM (GMT 0)

Diamonds........glad to see you're on the other side. Tarhoosier is correct about the way the the two G7's act. I too had an upgrade from a G6 at biopsy to a G7 (3+4) in the path report. I'm 2 + years out from surgery at U. of Penn, and still have undetectable PSA. Who was your surgeon? Several of us here had Dr. Lee at Penn, but I recall in an earlier post that you might have had a different surgeon. I would also agree with TH, that at this point, you wait and see how your PSA levels are before jumping to any conclusions.

Arnie in DE

Posted 3/16/2011 6:31 PM (GMT 0)
I don't hold the view that 3+4 is less dangerous than a 4+3. I was downgraded from a 4+3 to a 3+4 after surgery, with one teeny weeny positive margin. I had recurrance within 9 months of surgery, and needed salvage radiation, which has recently failed too. Does not mean you husband will not do well, hopefully he will. Depends too on how aggressive the "4" portion is within itself. May definitely be worth getting a second opinion on this post surgery pathology work.

I hope he does very well and has a sting of "zeros" far ahead of him.

David in SC
Posted 3/16/2011 6:55 PM (GMT 0)
Congratulations on your surgery, and like everyone else, I hope the one positive margin turns out to be of no real significance.

Aren't you glad, though, that you didn't choose "active surveillance" based on the 3+3 biopsy path report, later confirmed by Dr Epstein on review as 3+3, but which turned out to be 3+4 with a small positive margin?

I'm a 3+4 guy, and I'd rather be a 3+3, but from what I've gathered here, PCa is always an "iffy" thing, and the cancer doesn't seem to follow the rules very well, so vigilance is always necessary.  Hopefully, your numbers will be zeroes.

I think I would be giving my surgeon a call to get some further clarification and ask him the same follow-up questions you're asking here.  That might bring you some peace of mind.

 

Posted 3/16/2011 7:23 PM (GMT 0)
Dear Arnie,

Dr. Eun did the surgery. He learned robotics from Dr. Menon at the Henry Ford clinic and phas privilages at all the Penn hospit but does robotic at Pennsylvannia Hosp.

Posted 3/16/2011 8:11 PM (GMT 0)
Some interesting reading on gleason 7 , for those interested..........Kev



http://www.prostate-online.com/gleason7.html
Posted 3/17/2011 4:53 PM (GMT 0)
Di:
We may be typing past each other here. You refer to the "surgical report" and I mention the pathologist report. I hope those are the same thing. Surgeons have "op notes" or a transcript of the running comments from surgery that reflect all the discussion and decisions and findings made during the procedure in the OR. That is different from the pathologist report on the tissue removed. Perhaps we are discussing the same thing.
You may ask your surgeon to explain the findings in detail until you understand them. Include in your questions the amount or percentage of G3 and 4. This could be expressed in volume or mass or percentages. Your man has a right to copies, made at his expense, of all notes, reports, findings and such in his record.
Again, healing first. Then start with psa readings and all will be apparent in good time. Patience is difficult at this stage. It is a virtue, seldom found.
Posted 3/17/2011 9:22 PM (GMT 0)
You should remember that margins are measured under a microscope and so many of them are very small. With small positive margins the cells may have been cut off from their blood supply and have already died.

But more important -- what happened in surgery is in the past. You and your husband need to look to the future. First to healing (as we say, walk, walk, walk, drink, drink, drink). Followed by live, live, live.

No one can tell you what the future holds, but you have studied and are prepared for it. You have no choice about the future, but do not let uncertainty pollute the present.
Posted 3/18/2011 12:35 AM (GMT 0)
Surgical report and Pathology report are two very different things.

As already noted:

Surgical report is a report of the flow of the operation itself.

Pathology report is the written analysis of the condition of the prostate, seminal vesticles, and any lymph nodes forwarded to the pathologist.

I was not immediately offered a copy of the surgical report, but for insurance purposes I was required to get a copy. It was about as useless as .... well, it didn't tell me much more than the names of the staff and that things went not perfectly, but within what I already knew.

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